Prevention Versus a Good Idea

The United States preventative service task force abbreviated USPSTF is an organization that is supposed to make evidence-based recommendations regarding health decisions for screening that improve health and prolong life. Cost is not a factor in that decision making, but only benefits and harms are reviewed. We will not present all of the 88 recommendations here by any means although they are readily available on the Internet and many of them reviewed periodically in medical offices.

To be sure these measures share some overlap with the American Cancer Society guidelines, but the USPSTF goes beyond merely screening for cancer. The decisions made by the task force is not supposed to be political or even truly economical as noted, but rather based on harm versus benefit. That having been said, we will discuss some legitimate criticism to show how important it is to have a discussion with your clinician about any test rather than to blindly except the testing.

One popular item is that of mammograms. The committee recommended that the screening for breast cancer be changed in the 40 to 49 group for routine screens to be done yearly as to be opposed to getting the yearly testing at age 50. The rationale was that it would improve health equity among different social economic groups. The problem with this rationale is that there were no trials establishing that. On the other hand, the Netherlands found that gradually linking the testing interval from one year to 2 1/2 years, reduced not only cost, but also harm without compromising the benefit. People sometimes tend to overlook the fact that the radiation burden of mammograms is itself is a risk factor for cancer.

Another recommendation is that of the lung cancer screening for individuals at risk, notably smokers age, 50 and up with so many years of smoking. The current recommendation is annual low-dose CT screens for high-risk individuals. Once again, though a large trial in the Netherlands demonstrated that every two-year screening offers  the equal benefits with lower cost and lower harms.

Colon cancer screening by colonoscopy specifically is a strong endorsement. This endorsement made an assumption of reduction mortality of over 2 1/2% starting in age 50 in adult adults to a 74. The problem is there were no randomized controlled trials at the time of that recommendation, but subsequently the benefit was found to be much smaller, in fact around 0.15% for mortality reduction.

Another fine idea with little proof was that of screening for anxiety disorder in adults, a rather common condition. The theory was that such screening tests are accurate, and that treatment was effective. However, when large trials were examined, there was no established benefit of screening for anxiety. The same was true for screening for unhealthy drug use in adults. There is a recommendation to screen routinely because such test were reported as accurate and that treatment would improve outcomes. However, there’s no actual studies that confirm the benefit.

Keep in mind that the phrase “it only stands to reason” is a substitute for lack of actual evidence, but only based on theory that we would like to make sense. Ultimately, we need scientific data before they can have endorsement. Until such time measures like these are good discussions, but not absolutely proven.